The Impact Of California’s Behavioral Health Services Act (bhsa) On The Need And Utilization Of Behavioral Health Services In California Counties

Author

Lucia ShenFollow

Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Katie Wang

Abstract

This thesis evaluates the impact of California’s Behavioral Health Services Act (BHSA) on behavioral health need and service utilization across 44 California counties from 2001 to 2023. Using data from the California Health Interview Survey and Department of Health Care Services expenditure reports, this study employs time-series visualizations and Ordinary Least Squares panel regressions to assess whether BHSA investments are associated with reduced behavioral health need and increased service use. Statewide trends show that while behavioral health needs rose steadily, utilization increased moremodestly, resulting in a persistent access gap. Some counties, such as Nevada, Monterey, and Mendocino, exhibited temporary convergence between need and utilization, while others, including Los Angeles and rural counties, continued to show persistent disparities. Regression results indicate that increased BHSA spending is generally associated with decreased behavioral health need, particularly in Stanislaus, Placer, and Kings. However, effects on utilization were more varied: Monterey and Santa Cruz showed statistically significant gains, while several counties (including Mendocino and Orange) showed declines. Disaggregating BHSA expenditures into five program components revealed that Prevention and Early Intervention (PEI) and Capital Facilities and Technological Needs (CFTN) were most consistently linked to need reduction. These findings underscore that while funding is necessary, it is not sufficient to ensure equitable behavioral health access. Outcomes depend heavily on local implementation and the ability to address structural barriers. This study highlights the importance of context-sensitive, equity-driven strategies to maximize the impact of behavioral health investments across diverse communities.

Comments

This is an Open Access Thesis.

Recommended Citation

Shen, Lucia, "The Impact Of California’s Behavioral Health Services Act (bhsa) On The Need And Utilization Of Behavioral Health Services In California Counties" (2025). Public Health Theses. 2549.
https://elischolar.library.yale.edu/ysphtdl/2549